Categorized | Coaching, General

Health Insurance for Athletes MADE SIMPLE!

If you’re shopping for health insurance, get ready for a headache.

You might think you know what a deductible is. But do you understand co-insurance percentages, in-network vs. out-of-network or out-of-pocket max. I didn’t, and honestly, I don’t want to think about it anymore.

But I hope that the hours I spent figuring it out, filling out online “choose the best plan for me” questionnaires and asking questions of multiple insurance sales people pay off if I end up in the hospital.

And given the fact that I practice a combat sport, I know the time was well spent.

You can’t imagine how expensive hospitals can be. A tiny trip to the emergency room can set you back a thousand dollars. An overnight stay, tens or hundreds. A recent New York Times article profiled a 28-year-old woman whose 46-hour stay in a NYC hospital for a digestive illness called diverticulitis cost her $17,398.

Here’s a link to the story, about how young people are chronically uninsured, to the tune of 13.2 young people nation wide: http://www.nytimes.com/2009/02/18/nyregion/18insure.html?_r=1&scp=3&sq=uninsured&st=cse

That said, here are things to think about when you’re buying health insurance. Most of the insurance company websites have questionaires that help you narrow down choices, and then provide tables that you can print to compare options between plans (and companies) — though some companies use different terminology for the same thing, so ASK QUESTIONS.

How often do you go to the doctor, and what for? Ex: regular office visits, specialist visits, hospital stays

Where do you go to the doctor? Do you most often visit your home doctor? Or are you traveling a lot and relying on walk-in clinics around the country? What about outside of the U.S.? Some plans are split into in-network and out-of-network rates and there can be a huge discrepancy between them. For example, when I looked into an Aetna plan, I found that the out-of-pocket max was thousands of dollars higher if the physician or health care center was out-of-network, and the representative on the phone told me that any physician outside of the state of Florida would be considered out-of-network. For a BJJ competitor who travels, that was not the plan to choose.

Meanwhile, when I spoke to Blue Cross Blue Shield about a plan with a comparable deductible, the out-of-pocket max was much lower for both in- and out-of-network doctors — and the representative told me that it would be considered in-network around the country and in many countries outside of the U.S.

How many prescriptions do you take and how often? Are you content with generics, which are usually cheaper? Do you have any prescriptions that you take monthly, or do you usually only take them when prescribed for a specific sickness or incident?

How much do you want to pay per month? Lower monthly payments usually mean less coverage, but if you’re going to pay a big chunk each month make sure you actually need the coverage you’re paying for.

How much can you afford to pay in a crisis?Think about and study your plan’s deductible, co-insurance and out-of-pocket max. You’re probably familiar with the term deductible, but you might not have any idea what co-insurance and out-of-pocket maxes are. I found that with both Aetna and Blue Cross and Blue Shield it took me multiple phone calls and multiple attempts to ask questions to get answers to those questions. Each plan is different, so make sure you understand the intricicies of the one you’re signing up for — and exactly how much the maximum you’d be required to pay is.

Who else do you need to insure? If you’re married or have children, you can usually include them in your plan (for a higher price, of course). Children over age 18 are often eligible into their early twenties as long as they’re in college, but otherwise, they’re not. If you’re gay, and you’ve lived with your partner for a certain period of time you can often purchase coverage together. Straight unmarried couples aren’t usually eligible to apply together.

Once you’ve actually selected a plan, your work isn’t done. Plan on about a month between when you submit your application and when your coverage will start — provided there aren’t any problems. Also, plan on spending a good hour or so on the online application, because they’ll ask you to record every single detail about every time that you went to a doctor in the last 10 years.

The company may also call you and ask questions about any of those doctor visits. They called me to ask about arthritis in my big toe — even though I’m a healthy, 24-year-old male. Keep in mind that the quoted rates assume that you’re healthy, so if you have a pre-existing medical condition they might slap you with a higher monthly premium.

It took me a long time to research, ask questions, apply and wait for approval — but in the end, I think it’s worth it to have the peace of mind that I’m covered in case something happens.

One Response to “Health Insurance for Athletes MADE SIMPLE!”

  1. kevin dalton says:

    some great info in here. i wish i had this when i was 21! very helpful…i had to learn on my own.$$$$

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